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Guideline on the use of iodinated contrast media in patients with kidney disease 2018

JSN/JRS(radiology)/JCS · 2019 · Japan

Source and licence

Authors
Yoshitaka Isaka, Hiromitsu Hayashi, Kazutaka Aonuma et al.
Title
Guideline on the use of iodinated contrast media in patients with kidney disease 2018
Journal
Clinical and Experimental Nephrology, 2019
DOI
10.1007/s10157-019-01750-5
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC6949208

Licence statement of the original publication

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

3.6 CQ3-7 Does the use of NSAIDs increase the risk of developing CIN?

  • We recommend against the use of NSAIDs owing to an increased risk of developing CIN.Level of Evidence: II/Grade of Recommendation: C2

5.1 CQ5-1 Does the risk of developing CIN after CAG increase in CKD patients?

  • We recommend that physicians explain CIN to patients with an eGFR < 60 mL/min/1.73 m2 who will undergo CAG and that they emphasize the need for appropriate preventive measures such as fluid hydration before and after CAG.

7.1 CQ7-1 Does physiological saline hydration decrease the risk of developing CIN?

  • We recommend using physiological saline intravenously before and after contrast-enhanced examination in CKD patients, as they are at high risk of developing CIN.
  • We recommend using isotonic solutions to prevent CIN because isotonic 0.9% sodium chloride (physiological saline) is superior to hypotonic 0.45% sodium chloride in preventing CIN.

10.1 CQ10-1 Dose loop diuretics therapy improve renal recovery after CIN onset ?

  • We recommend against the use of loop diuretics for the treatment of CIN because the evidence that loop diuretic administration after CIN onset suppresses the progression of renal dysfunction is poor, and their use may actually cause harm.Level of Evidence: VI/Grade of Recommendation: C2

10.3 CQ10-3 Dose low-dose dopamine therapy improve renal recovery after CIN onset ?

  • We recommend against the use of low-dose dopamine for the treatment of CIN because it does not improve recovery from AKI.Level of Evidence: II/Grade of Recommendation: D

Contents of the original publication

The section headings of the original.

  • 1. Outline of the revised version of the guideline on the use of iodinated contrast media in patients with kidney disease
  • 1.1 Purpose of the revision of the guideline
  • 1.2 A cautionary note on the use of the present guideline
  • 1.3 Selection of literature, levels of evidence, and grades of recommendations
  • 1.4 Independent assessment
  • 1.5 Future plans
  • 2 Diagnosis of contrast-induced nephropathy (CIN)
  • 2.1 CQ 2-1 How CIN should be diagnosed?
  • 3 Risk factors and patient assessment
  • 3.1 CQ3-1 Does the risk of developing CIN increase in CKD patients?
  • 3. 2 CQ 3-2 Does aging increase the risk of developing CIN?
  • 3.3 CQ 3-3 Does diabetes mellitus increase the risk of developing CIN?
  • 3.4 CQ3-4 Does the use of renin-angiotensin system (RAS) inhibitors increase the risk of developing CIN?
  • 3.5 CQ3-5 Does the continuation of diuretics increase the risk of developing CIN?
  • 3.6 CQ3-7 Does the use of NSAIDs increase the risk of developing CIN?
  • 3.7 CQ3-8 Does the use of iodinated contrast media increase the risk of lactic acidosis in patients receiving biguanide anti-hyperglycemic drugs?
  • 3.8 CQ3-9 Does the development of CIN worsen the vital prognosis of patients with CKD?
  • 3.9 CQ3-10 Does the use of contrast media increase the risk of a decline in residual kidney function in patients undergoing peritoneal dialysis?
  • 3.10 CQ3-11 Are risk scores useful as predictors of CIN development?
  • 3.11 CQ3-12 Does a solitary kidney increase the risk of developing CIN?
  • 4 Type and volume of contrast media
  • 4.1 CQ4-1 Does the risk of developing CIN differ between iso- and low-osmolar contrast media?
  • 4.2 CQ4-2 Does the risk of developing CIN differ among the different low-osmolar contrast media?
  • 4.3 CQ4-3 Is the risk of developing CIN higher in patients receiving contrast media via intra-arterial administration than in those receiving contrast media via intravenous administration?
  • 5. Intra-arterial contrast media administration
  • 5.1 CQ5-1 Does the risk of developing CIN after CAG increase in CKD patients?
  • 5.2 CQ5-2 Does the use of a smaller volume of contrast media decrease the risk of developing CIN?
  • 5.3 CQ5-3 Does repeated CAG at short intervals increase the risk of developing CIN?
  • 5.4 CQ5-4 Does the risk of developing CIN after PCI increase in CKD patients?
  • 5.5 CQ5-5 How can CIN be differentiated from kidney injury due to cholesterol embolism?
  • 5.6 CQ5-6 Does the onset of CIN increase cardiovascular events?
  • 5.7 CQ5-7 Does the risk of developing CIN/AKI increase with TAVR in CKD patients?
  • 6 Intravenous contrast media administration
  • 6 1 CQ6-1 Does the risk of developing CIN increase in CKD patients after contrast-enhanced CT?
  • 6.2 CQ6-2 Does the risk of developing CIN increase in intensive care patients and severe emergency outpatients after contrast-enhanced CT?
  • 6.3 CQ6-3 Does reduction of the contrast media volume in contrast-enhanced CT decrease the risk of developing CIN?
  • 6.4 CQ6-4 Is there a recommended scan method for decreasing contrast media usage in contrast-enhanced CT?
  • 6.5 CQ6-5 Does repeated contrast-enhanced CT at short intervals increase the risk of developing CIN?
  • 7. Prevention of CIN; hydration therapy
  • 7.1 CQ7-1 Does physiological saline hydration decrease the risk of developing CIN?
  • 7.2 CQ7-2 Does oral water intake decrease the risk of developing CIN?
  • 7.3 CQ7-3 Does sodium bicarbonate-based hydration decrease the risk of developing CIN?
  • 7.4 CQ7-4 Is short-term intravenous sodium bicarbonate hydration as effective as standard intravenous hydration in preventing CIN?
  • 8. Prevention of CIN: pharmacologic therapy
  • 8.1 CQ8-1 Does the administration of NAC prevent CIN onset?
  • 8.2 CQ 8-2 Does administration of hANP prevent CIN onset?
  • 8.3 CQ 8-3 Does administration of ascorbic acid prevent CIN onset?
  • 8.4 CQ 8-4 Does administration of statins prevent CIN onset?
  • 9 Prevention of CIN; blood purification therapy
  • 9.1 CQ9-1 Does blood purification therapy conducted after contrast exposure as a measure to prevent CIN decrease the risk of developing CIN?
  • 10 Treatment of CIN
  • 10.1 CQ10-1 Dose loop diuretics therapy improve renal recovery after CIN onset ?
  • 10.2 CQ10-2 Dose hydration therapy improve renal recovery after CIN onset ?
  • 10.3 CQ10-3 Dose low-dose dopamine therapy improve renal recovery after CIN onset ?
  • 10.4 CQ10-4 Does hANP treatment in CIN patients improve recovery from AKI?
  • 10.5 CQ10-5 Does acute blood purification therapy improve the outcome of renal function in patients with CIN?

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